From: Matt Binder <binder@well.sf.ca.us>
Date: Sat, 27 Nov 93 17:44:18 PST
To: cypherpunks@toad.com
Subject: health privacy radio program
Message-ID: <199311280141.RAA15079@well.sf.ca.us>
MIME-Version: 1.0
Content-Type: text/plain


Thanks for your help with my story about medical record privacy. 

Working on the story was a real education for me, (getting to meet
all kinds of interesting people is one of the main reasons why I'm
a reporter) and I had a few good coincidences that added some
"atmosphere" to the piece.  I've included the entire script below.
I hope I'm not being presumptuous.

The show in which my 8.5 minute piece aired is called "The
Communications Revolution, produced by the Telecommunications Radio
Project, which is headquartered at KPFA-FM in Berkeley.  The
project is funded by the California Public Utilities Commission,
through the Telecommunications Education Trust (TET), which is
basically money that was overpaid to Pac Bell by its customers. 
Other TET grantees are Gregg McVicar's "Privacy Project", and Beth
Given's "Privacy Rights Clearinghouse" in San Diego.  Our project
is a series of 13 one hour, live, satellite- linked panel
discussion and call-in shows that air on about thirty stations
around the country (but especially in California).


show: HEALTH PRIVACY    Matt Binder   11/12/93    draft FINAL

****************************************************************
*** cut 1 *** dramatic reading of condensed version of
		Hippocratic Oath (Ed Markman)
   in: "I swear by Apollo Physician, by Asclepius, by Health, and
by all the gods and goddesses that I will carry out this oath: 
into whatsoever houses I enter, I will enter to help the sick,
and whatsoever I shall see or hear in the course of my
profession, if it be what should not be published abroad, I will
never divulge, holding such things to be holy secrets...."   	
(then fade)
****************************************************************

SINCE THE TIME OF ANCIENT GREECE, DOCTORS HAVE UNDERSTOOD THE
SENSITIVE NATURE OF THEIR PROFESSION, AND HAVE RECITED THIS, THE
HIPPOCRATIC OATH, AS A PROMISE OF CONFIDENTIALITY.  UNTIL
RECENTLY PHYSICIANS HAVE KEPT THE SECRETS OF THEIR PATIENTS IN
THEIR HEADS, OR ON PIECES OF PAPER IN A FILE.  AND THEY'VE BEEN
THE GATEKEEPERS FOR OTHERS WANTING TO SEE THIS EXTREMELY PRIVATE
INFORMATION.  BUT NOW, FOR SOME VERY GOOD REASONS, THAT'S ALL
BEGINNING TO CHANGE.

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--- ambience 1 --- dialysis machine				(2:00)
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--- ambience 2 --- ventilator						(2:00)
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--- ambience 3 --- Dr. Ting talking to patient		(1:30)
		(3 possible starting points)
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AT THE DIALYSIS UNIT AT EL CAMINO HOSPITAL IN MOUNTAINVIEW
CALIFORNIA, DOCTOR GEORGE TING USES A COMPUTER TO KEEP RECORDS,
ORDER TESTS AND PRESCRIBE DRUGS FOR HIS PATIENTS.  HE SAYS THE
COMPUTER SAVES HIM HOURS EACH WEEK, AND CAN EVEN SAVE LIVES...

****************************************************************
*** cut 2 *** Dr. Ting                         :15
  in: "For instance if you're ordering a medication on a patient,
it automatically gives you the most common prescribing doses and
frequency.  It does make it less likely that you're gonna make
some major mistake, prescribing ten times the usual amount."
   (then fade)  
****************************************************************

----------------------------------------------------------------
--- ambience 4 --- Nurse Holt working at computer		(1:10)
----------------------------------------------------------------

----------------------------------------------------------------
--- ambience 5 --- computer printer				(1:05)
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NURSE JUDY HOLT IS AN EVEN STRONGER PROPONENT OF THE COMPUTER.
WHEN NEW DOCTORS COME TO THE HOSPITAL AND RESIST USING THE
COMPUTER SYSTEM, SHE AND OTHER NURSES PRESSURE THEM TO GET WITH
THE PROGRAM...

****************************************************************
*** cut 3 *** Holt                        :17
  in: "We're all anxious to help them learn how to use the
computer because it saves us time, it saves the possibility of
transcription errors, it saves: 'I can't read this doctor's
writing, what on earth does it say,' and if three of us looked at
it and can't figure it out, we've gotta call him..."
    (then fade) 
****************************************************************

BUT THE COMPUTERIZATION OF MEDICAL RECORDS HAS A DOWNSIDE:
AMASSING HUGE DATABASES OF SENSITIVE INFORMATION COULD OPEN THE
DOOR TO PRIVACY INVASIONS ON A SCALE UNIMAGINABLE WITH PAPER
FILES.  IT'S ALREADY HAPPENING.  INSURANCE COMPANIES AND DIRECT
MARKETERS, AIDED BY COMPUTERS ALL LINKED TOGETHER BY PHONE LINES
ARE FINDING WAYS TO GET AHOLD OF MEDICAL DATA, AND THEY'RE
SELLING AND TRADING IT ACROSS VAST NETWORKS.

----------------------------------------------------------------
--- ambience 6 --- Taylor answering door on Halloween	(1:00)
  in: "Trick or Treat!..."
----------------------------------------------------------------

IT'S HALLOWEEN NIGHT AT THE HOME OF MARY ROSE TAYLOR IN
SPRINGFIELD MASSACHUSETTS.  TAYLOR RECENTLY FOUND OUT HOW EASY IT
IS TO GET TRAPPED IN ONE OF THOSE DATA WEBS.  SHE APPLIED FOR
HEALTH INSURANCE BUT WAS REJECTED BECAUSE OF A COMPUTER ERROR AT
THE MEDICAL INFORMATION BUREAU, OR MIB, A HUGE MEDICAL DATABASE
KEPT BY INSURANCE COMPANIES...

****************************************************************
*** cut 4 *** Taylor                      :20
  in: "They had my name on a urinalysis that wasn't mine, and
they refused to think that there was any kind of mistake or
mixup, and I went without insurance for a year and a half, and
had to literally go to my state representative, the insurance
commissioner just to have it corrected."
****************************************************************

TAYLOR TOLD MIB AND HER INSURANCE COMPANY THAT SHE'D HAD ONLY A
BLOOD TEST, NOT A URINE TEST, AND THEREFORE THE ABNORMAL
URINALYSIS COULDN'T POSSIBLY BE HERS.  BUT THE INSURANCE COMPANY
INSISTED THAT SHE GAVE A URINE SAMPLE, THAT IT SHOWED THERE WAS
SOMETHING WRONG WITH HER, THOUGH THEY WOULDN'T TELL HER WHAT IT
WAS...

****************************************************************
*** cut 5 *** Taylor                      :14
  in: "At one point the risk manager had me in tears (sniff).  He
was very nasty, really.  You know, and his words, what he said to
me was that computers don't make mistakes.  I said I agree, but
the people that feed the computer do.  
****************************************************************

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--- ambience 5 comes up full again --- more Halloween sound 
	(then fades out completely before next cut starts)
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****************************************************************
*** cut 6 *** Anonymous (ALTERED VOICE)             :10
  in: "I'm paying fifteen thousand a year for disability,
personal disability and medical insurance, and that seems like a
whole heck of a lot of money..."   (then fade)
****************************************************************

ANOTHER VICTIM OF A MEDICAL INFORMATION BUREAU ERROR IS THIS
DOCTOR FROM SOUTHERN CALIFORNIA WHO WANTS TO REMAIN ANONYMOUS.
WHEN SHE ASKED HER INSURANCE COMPANY WHY HER RATES WERE SO HIGH,
THEY TOLD HER THAT HER MIB FILE SHOWED THAT SHE HAD ALZHEIMER'S
DISEASE AND A HEART CONDITION...

****************************************************************
*** cut 7 *** Anonymous (ALTERED VOICE)            :23
  in: "Here I am a physician who works sixteen hours a day, who's
never been in the hospital has Alzheimer's disease and a heart
attack!?  That doesn't make sense.  I don't think computers and
the people who put information into the computer are advanced
enough to have such control over our lives."
****************************************************************

****************************************************************
*** cut 8 *** Binder stand-up at MIB                       :24
  in: "I'm now standing outside the entrance to MIB Incorporated
in Westwood Massachusetts.  I've been trying for over two months
to get an interview with the president of the company, Neil Day. 
He says he doesn't have the time, and no one else can speak for
the company.  But he did admit during a telephone conversation we
had that four percent of the 16 million computerized medical
records in this building do have errors in them."
****************************************************************

****************************************************************
*** cut 9 *** Smith                            :10
  in: "I don't think MIB really needs the good will of consumers,
as does a retail store, and in many ways the less known about MIB
the better perhaps for insurance companies."
****************************************************************

ROBERT ELLIS SMITH IS THE EDITOR OF PRIVACY JOURNAL IN PROVIDENCE
RHODE ISLAND...

****************************************************************
*** cut 10 *** Smith                       :23
  in: "The ancient Greeks knew as others did that for medical
care to work properly, you have to be totally candid to your
doctor.  But now instead of a one on one relationship there is a
triangle among the provider, your insurance company and your
employer, and medical information about us flows throughout that
triangle without our participation.  And that's the crisis we're
in right now."
****************************************************************

AFTER THE INSURERS AND EMPLOYERS, IT'S PHARMACEUTICAL COMPANIES
AND DIRECT MARKETERS THAT ARE THE MOST AVID COMPILERS OF MEDICAL
INFORMATION.  SOME OF THESE COMPANIES HAVE TOLL-FREE TELEPHONE
NUMBERS YOU CAN CALL TO GET FREE SAMPLES OF THEIR PRODUCTS.  WHAT
THEY DON'T TELL YOU WHEN YOU CALL IS THAT YOUR PHONE NUMBER AND
OFTEN YOUR NAME AND ADDRESS AUTOMATICALLY POPS UP ON THEIR
COMPUTER SCREENS, AND YOUR PERSONAL PROBLEM, WHETHER IT BE
ALLERGIES OR HEMORRHOIDS GOES RIGHT INTO THEIR DATABASE.  AGAIN
THE COMPANIES THAT RUN THESE DATABASES REFUSED TO TALK ABOUT
THEM.

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--- ambience 6 --- Apter talking on phone
----------------------------------------------------------------

ONE MAN WHO'S NOT SHY AT ALL ABOUT HIS DATABASE SNOOPING IS JOE
APTER, PRESIDENT OF TELEPHONIC-INFO INCORPORATED OF SAINT
PETERSBURG FLORIDA.  HIS COMPANY ACTUALLY HAS A PRICE LIST OF
INFORMATION YOU CAN OBTAIN: $49 FOR SOMEONE'S SOCIAL SECURITY
NUMBER; $299 WILL GET YOU SOMETHING CALLED A "MEDICAL PROFILE"
THAT APTER WOULDN'T ELABORATE ON, BUT WHICH HE SAYS COMES FROM 
LEGAL SOURCES...

****************************************************************
*** cut 11 *** Apter                       	:24
  in: "There are people out there that are providing medical
records on an illegal basis.  And the method they would use to
obtain that would be a pretext into a doctor, and they'd have to
know the doctor, or a pretext in the insurance company to get
that information.  We don't do that.  

or: *** alternate cut 11 *** Apter			:24
  in: "You and I are leaving threads as we go around, and we find
those threads and we weave them together to get a picture.  There
are people out there that are providing medical records on an
illegal basis.  We don't do that." 
****************************************************************

****************************************************************
*** cut 12 *** Hippocratic oath
  (fades in under last cut, up full for a couple of seconds, then
under next cut, then up again after next cut.)
****************************************************************

****************************************************************
*** cut 13 *** Smith                          :22
  in: "I think the answer is for patients to insist that doctors
go back to that ancient ethical standard, and insist that they
not disclose information about them without their informed
consent totally.  The concept of informed consent about the
release of medical information seems to have gotten lost in the
modern age."
****************************************************************

(Hippocratic Oath comes up full again, then down briefly for soc
out)

I'M MATT BINDER FOR THE COMMUNICATIONS REVOLUTION.